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A measles outbreak in Minnesota has reached 69 cases total and is costing public health departments thousands of dollars as they try to track, treat and control the spread of this disease. Among the 69 confirmed cases, 65 have been confirmed in people who are unvaccinated. In addition, 66 of the cases occurred in children under 18 as reported by the Minnesota Department of Health.

Due to the high percentage of children affected, state health officials are trying to reach parents who are skeptical or afraid of the measles vaccine. Much of the parental fear surrounding vaccines can be traced to a 1998 article published in the Lancet by Andrew Wakefield that linked autism to vaccines. The article suggested that the Measles, Mumps, Rubella, or MMR, vaccine may predispose children to behavioral regression and pervasive developmental disorders, and that’s when MMR vaccination rates began to drop.

The Lancet article and Wakefield have been discredited. Several articles have been published refuting the link between MMR vaccination and autism, and the Lancet retracted the article, admitting that several elements in the paper were wrong. Wakefield’s British medical credentials have been revoked. But the article had already planted fear in the minds of many parents, and vaccine opponents began to speak out publicly against using vaccines.

So how effective is the measles vaccine? The simplest measure is the rapid decline in measles after the invention of the MMR vaccine. According to the CDC, the measles vaccine was first introduced in the United States in 1963. At that time, there were an estimated three to four million confirmed cases each year, causing 48,000 hospitalizations and 500 deaths annually. By 2000, the virus was declared eliminated due to widespread vaccination efforts across the United States. Since then, the number of cases has been sporadic, with 116 cases in 2001 down to 70 in 2016. Interestingly, there was a large spike in cases, at 667, in 2014 due to a rash of outbreaks around the country.

State laws vary on vaccination requirements for children entering kindergarten. Looking at the 2015-16 school year, 22 states reported 95 percent or more kindergarten children being vaccinated with two doses of MMR. Montana, North Carolina and Utah added a requirement starting with the 2015-16 school year for two MMR doses, increasing the number of states requiring two doses to 42 states total. Looking back 10 years to the 2006-07 school year, measles vaccination coverage was actually higher as 35 states reported 95 percent or more coverage for MMR.

Several states do allow vaccination exemptions for medical, religious or philosophic reasons. For the 2014-15 school year, 11 states reported 4 percent or less of kindergarten parents claiming exemptions. This number dropped to nine states with a 4 percent or less exemption rate for the 2015-16 school year. A majority of states saw a slight increase in the exemption rate. (See the full CDC vaccination coverage report for 2015-16 here.)

Now Minnesota faces the most recent outbreak and it is taking a toll on the state’s public health system, which reported 70 employees actively working on the problem and $207,000 spent in the first three weeks of the outbreak. The Minnesota Department of Health estimates that 90 percent of people who are not vaccinated will catch measles if they are exposed. And for every confirmed case, state and local health officials are tasked with tracking down hundreds of people who may have been exposed to that case.

In response to this unplanned burden, Minnesota Health Commissioner Ed Ehlinger has asked the state legislature for $5 million for an emergency fund to deal with the recent measles outbreak and other infectious diseases plaguing the state.

The Centers for Disease Control, along with a majority of health experts, recommend that state health departments have action plans to react to outbreaks as well as plans to help prevent future outbreaks. ­